68 elderly patients with lumbar spinal stenosis were randomized to receive either open lumbar decompression (n=34) or lumbar decompression using a large-channel spinal endoscopy (n=34). The outcomes of interest included operative time, intraoperative blood loss, drainage volume, length of stay, pain on a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, disc height, alignment angles, clinical effectiveness, and the incidence of adverse events. Surgical parameters such as operative time, intraoperative blood loss, drainage volume, and length of stay were significantly better in the endoscopy group. Similarly, pain scores, ODI, and JOA scores were also significantly lower in the endoscopy group at all time points. The use of an endoscopy approach for lumbar spinal stenosis can significantly improve intraoperative, pain, and functional outcomes after one year, with better clinical effectiveness and lower adverse event rates compared to an open lumbar decompression technique.